Contextual Influences on Modern Contraceptive Use in Sub-Saharan Africa

Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Ga 30322, USA.
American Journal of Public Health (Impact Factor: 4.55). 08/2007; 97(7):1233-40. DOI: 10.2105/AJPH.2005.071522
Source: PubMed


We examined the role of community-level factors in explaining geographic variations in modern contraceptive use in 6 African countries.
We analyzed Demographic and Health Survey and contextual data sources with multilevel modeling techniques to identify factors contributing to geographic variations in women's use of modern contraceptives.
We found significant associations between several community-level factors and reported use of modern contraceptive methods. We also identified several pathways of influence between the community and the individual.
Aspects of a community's sociocultural and economic environment appear to influence a woman's use of modern contraceptive methods.

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    • "Lutz and Kc (2011) noted that this pattern is typically more pronounced in countries that have high fertility levels and that are in the early stages of demographic transition. In particular, some scholars suggest that more educated women have greater autonomy in reproductive decisionmaking and engage in more intensive parenting to ensure a better quality of life for their children (e.g., Martin, 1995; Kravdal, 2000; Basu, 2002; Manda and Meyer, 2005; Stephenson et al., 2007; Lutz and Kc, 2011). "
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    ABSTRACT: Many studies have suggested that there is an inverse relationship between education and number of children among women from sub-Saharan Africa countries, including Malawi. However, a crucial limitation of these analyses is that they do not control for the potential endogeneity of education. The aim of our study is to estimate the role of women’s education on their number of children in Malawi, accounting for the possible presence of endogeneity and for non-linear effects of continuous observed confounders. Our analysis is based on micro data from the 2010 Malawi Demographic Health Survey, by using a flexible instrumental variable regression approach. The results suggest that the relationship of interest is affected by endogeneity and exhibits an inverted-U shape among women living in rural areas of Malawi, whereas it exhibits an inverse (non-linear) relationship for women living in urban areas.
    Journal of Population Economics 01/2015; 28(1):89-111. DOI:10.1007/s00148-013-0502-8 · 0.92 Impact Factor
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    • "A fundamental factor in the study of contraceptive decision-making is the space/environment in which people operate [11]. It is now an increasingly recognized problem that to achieve the MDG goals in developing countries, one must integrate the spatial dimension [10, 12–15]. This proposed study involving spatial analysis sheds light for policymakers on repositioning family planning methods, specifically an understanding of birth intervals. "
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    ABSTRACT: Background The length of time between two successive live births (birth interval), is associated with child survival in the developing world. Short birth intervals (<24 months) contribute to infant and child mortality risks. Contraceptive use contributes to a reduction in short birth intervals, but evidence is lacking in the DRC. We aimed to investigate the proportion of short birth intervals at the provincial level among young women in the DRC. Methods Data from the Demographic and Health Survey undertaken in the DRC in 2007 were analyzed. Logistic regression and Bayesian geo-additive models were used to explain provincial inequalities in short birth intervals among women of reproductive age and young women. Posterior odds ratio (OR) and 95% credible region (CR) were estimated via Markov chain Monte Carlo (MCMC) techniques. Posterior spatial effects and the associated posterior probability maps were produced at the provincial-level to highlight provinces with a significant higher risk of short birth interval. Results The overall proportion of short birth intervals among all women of reproductive age (15–49 years) and young women (15–24 years) were 30.2% and 38.7% respectively. In multivariate Bayesian geo-additive regression analyses, among the whole sample of women, living in rural areas [OR = 1.07, 95% CR: (0.97, 1.17)], exclusive breastfeeding [1.08 (1.00, 1.17)] and women with primary education [1.06 (1.00, 1.16)], were consistently associated with a higher risk of short birth intervals. For the young women, none of the factors considered were associated with the risk of short birth interval except a marginal effect from the lack of education. There was a spatial variation in the proportion of women reporting short birth intervals and among all women of reproductive age across provinces, with Nord-Kivu [1.12 (1.02, 1.24)], Sud Kivu [1.17 (1.05, 1.29)] and Kasai Occidental [1.18 (1.06, 1.32)] reporting a higher risk of short birth intervals. For young women, the higher risk provinces were Nord-Kivu [1.22 (1.00, 1.54)] and Sud Kivu [1.34 (1.14, 1.63)]. Conclusions This study suggests distinct geographic patterns in the proportion of short birth intervals among Congolese women, as well as the potential role of demographic and geographic location factors driving the ongoing higher youth fertility, higher childhood and maternal mortality in the DRC.
    BMC Pregnancy and Childbirth 08/2014; 14(1):271. DOI:10.1186/1471-2393-14-271 · 2.19 Impact Factor
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    • "s the environment in which people operate , which is a core requirement for the proper availability and accessibility of contraception ( Borgoni & Billari , 2003 ) . Several studies on contraceptive use have concentrated on individual or household demographic and socioeconomic factors , such as determinants of the utiliza - tion of contraception ( Stephenson et al . , 2007 ) . However , the use of modern contracep - tion also has to integrate the geographic dimension , which is not often reported but can help capture certain local or shared factors such as cultural norms , as well as contracep - tive availability and accessibility ."
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    ABSTRACT: Summary This study investigates inequalities at the province level of the use of modern contraception and the proportion of short birth intervals among women in the DRC using data from the 2007 Demographic and Health Survey. Logistic regression and Bayesian geo-additive models were used. The posterior odds ratio and the associated 95% credible interval (95% CI) were estimated using Markov Chain Monte Carlo (MCMC) techniques. Posterior spatial effects were mapped at the province level with the associated posterior probability maps showing statistical significance at 5%. The overall rates of modern contraception use among the entire sample of women (15-49 years old; N=7172) and youth (15-24 years old; N=1389) were 5.7% and 6.0% respectively. However, there was striking variation in contraceptive use between the two groups across provinces with a clear east-to-west gradient. The highest use in the total sample was in Nord-Kivu (OR 1.32; 95% CI 1.12, 1.55) and Bas Congo provinces (1.47; 1.22, 1.78). For the youth, the highest use was observed in Nord-Kivu (1.19; 0.92, 1.65). In multivariate Bayesian geo-additive regression analyses among the entire sample of women, factors consistently associated with lower use of modern contraception were living in rural areas (0.71; 0.62, 0.82), living in low-income households (0.67; 0.54, 0.80) and having no education (0.83; 0.67, 0.97). For the youth sample, living in low-income households (0.57; 0.41, 0.84) and no breast-feeding (0.64; 0.47, 0.86) were consistently associated with a lower use of modern contraception. The study shows a distinct geographic pattern in the use of modern contraception in youth and the entire sample of women in the DRC, suggesting a potential role for socioeconomic factors, such as accessibility, affordability and availability, as well as environmental factors at the province level beyond individual-level risk factors.
    Journal of Biosocial Science 06/2014; 47(03):1-18. DOI:10.1017/S0021932014000212 · 0.98 Impact Factor
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